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Review
. 2017 Nov;6(4):360-374.
doi: 10.1159/000481315. Epub 2017 Oct 19.

Hepatocellular Carcinoma with Macrovascular Invasion: Defining the Optimal Treatment Strategy

Charlotte E Costentin  1 , Cristina R Ferrone  2 , Ronald S Arellano  3 , Suvranu Ganguli  3 , Theodore S Hong  4 , Andrew X Zhu  1
Affiliations
Review

Hepatocellular Carcinoma with Macrovascular Invasion: Defining the Optimal Treatment Strategy

Charlotte E Costentin et al. Liver Cancer. 2017 Nov.

Abstract

Background: Tumoral macrovascular invasion (MVI) of hepatic and/or portal vein branches is a common phenomenon in hepatocellular carcinoma (HCC) and is associated with poorer prognosis when compared to HCC without MVI.

Summary: Current international guidelines for the management of HCC recommend sorafenib as the only treatment option in case of MVI. Despite guideline recommendations, several alternative options have been tested to manage HCC with MVI: surgery, transarterial chemoembolization, external or internal radiation, hepatic arterial infusion chemotherapy, percutaneous treatment, cryotherapy, or the combination of two or more of these strategies, with or without sorafenib. Here we will provide a comprehensive state-of-the-art review for the management of this challenging clinical entity based on the most recent available data.

Key messages: There is a growing body of evidence suggesting that alternative strategies to standard-of-care sorafenib might improve survival in patients with advanced HCC with MVI but the level of evidence remains weak. Randomized phase III trials are ongoing and will hopefully provide information leading towards a more personalized treatment algorithm.

Keywords: Hepatocellular carcinoma; Macrovascular invasion; Sorafenib alternatives.

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Figures

Fig. 1
Fig. 1
Classification for hepatocellular carcinoma with portal vein tumor thrombosis according to the Liver Cancer Study Group of Japan classification.
See this image and copyright information in PMC

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